Abrams P, Andersson KE, Birder L Fourth international consultation on incontinence recommendations of the international scientific committee: evaluation and treatment of urinary incontinence, pelvic organ prolapse, and fecal incontinence. Neurourol Urodyn. 2010; 29:(1)213-240

, 6th edn. In: Abrams P, Cardozo L, Wagg A, Wein A (eds). Bristol: International Continence Society; 2017

Albers-Heitner P, Berghmans B, Nieman F, Lagro-Janssen T, Winkens R. How do patients with urinary incontinence perceive care given by their general practitioner? A cross-sectional study. Int J Clin Pract. 2008; 62:(3)508-515

Australian Institute of Health and Welfare. Incontinence in Australia. 2013. (accessed 21 September 2021)

Bolat D, Acar IC, Zumrutbas AE Prevalence of daytime urinary incontinence and related risk factors in primary school children in Turkey. Korean J Urol. 2014; 55:(3)213-218

Buckley BS, Lapitan MCM Prevalence of urinary incontinence in men, women, and children—current evidence: findings of the Fourth International Consultation on Incontinence. Urology. 2010; 76:(2)265-270

Central Statistics Office. Census 2016 results. Profile 7—migration and diversity. 2017. (accessed 30 September 2021)

Congress E. The culturagram, 2nd edn. In: In Roberts AR (ed). New York: Oxford University Press; 2008

Congress E, Kung W. Using the culturagram to assess and empower culturally diverse families, 4th edn. In: Congress E, Gonzalez M (eds). New York: Springer Publishing Company; 2020

Department of Health (UK). Valuing people: a new strategy for learning disability for the 21st Century. 2001. (accessed 21 September 2021)

Donnelly E, Neville L. Communication and interpersonal skills.Exeter: Reflect Press; 2008

Doshani A, Pitchforth E, Mayne CJ, Tincello DG. Culturally sensitive continence care: a qualitative study among South Asian Indian women in Leicester. Fam Pract. 2007; 24:(6)585-593

Doyle Y, McKee M, Rechel B, Grundy E. Meeting the challenge of population ageing. BMJ. 2009; 339

Doyle C, Byrne K, Fleming S, Griffiths C, Horan P, Keenan P. Enhancing the experience of people with intellectual disabilities who access health care. Learning Disability Practice. 2016; 19:(6)19-24

Du Moulin MFMT, Hamers JPH, Paulus A, Berendsen C, Halfens R. The role of the nurse in community continence care: a systematic review. Int J Nurs Stud. 2005; 42:(4)479-492

Elstad EA, Taubenberger SP, Botelho EM, Tennstedt SL. Beyond incontinence: the stigma of other urinary symptoms. J Adv Nurs. 2010; 66:(11)2460-2470

Fabrega H The study of disease in relation to culture. Behav Sci. 1972; 17:(2)183-203

Faculty of Public Health Medicine (Royal College of Physicians of Ireland). Migrant health—the health of asylum seekers, refugees and relocated individuals. 2016. (accessed 21 September 2021)

Gorina Y, Schappert S, Bercovitz A, Elgaddal N, Kramarow E. Prevalence of incontinence among older Americans. Vital Health Stat 3. 2014; 3:(36)1-33

Harris SS, Link CL, Tennstedt SL, Kusek JW, McKinlay JB. Care seeking and treatment for urinary incontinence in a diverse population. J Urol. 2007; 177:(2)680-684

Harris-Kojetin L, Sengupta M, Park-Lee E Long-term care providers and services users in the United States: data from the National Study of Long-Term Care Providers, 2013–2014. Vital Health Stat 3. 2016; (38)x-xii

Health Information and Quality Authority. Guidance for designated centres: Intimate Care. 2014. (accessed 21 September 2021)

Health Service Executive. Corporate plan 2015–2017. 2015. (accessed 21 September 2021)

Second national intercultural health strategy 2018-2023.Dublin: HSE; 2018

Higami Y, Yamakawa M, Kang Y Prevalence of incontinence among cognitively impaired older residents in long-term care facilities in East Asia: A cross-sectional study. Geriatr Gerontol Int. 2019; 19:(5)444-450

Horrocks S, Somerset M, Stoddart H, Peters TJ. What prevents older people from seeking treatment for urinary incontinence? A qualitative exploration of barriers to the use of community continence services. Fam Pract. 2004; 21:(6)689-696

Huang AJ, Brown JS, Kanaya AM Quality-of-life impact and treatment of urinary incontinence in ethnically diverse older women. Arch Intern Med. 2006; 166:(18)2000-2006

International Organization for Migration. The role of migrant care workers in ageing societies: Report on research findings in the United Kingdom, Ireland, Canada and the United States (IOM Migration Research Series 41). 2010. (accessed 21 September 2021)

Isaksen LW. Toward a sociology of gendered disgust: images of bodily decay and the social organization of care work. J Fam Issues. 2002; 23:(7)791-811

Keenan PM, Doody O. Intellectual disabilities-concepts and meanings. In: Keenan PM, Doody O (eds). Dublin: Nursing Network in Intellectual Disability Ireland; 2017

Keenan P, Fleming S, Horan P Urinary continence promotion and people with an intellectual disability. Learning Disability Practice. 2018;

Kinchen KS, Burgio K, Diokno AC, Fultz NH, Bump R, Obenchain R. Factors associated with women's decisions to seek treatment for urinary incontinence. J Womens Health (Larchmt). 2003; 12:(7)687-698

Kleinman A. Patients and healers in the context of culture.Berkeley, CA: University of California Press; 1980

Kleinman A, Eisenberg L, Good B. Culture, illness, and care: clinical lessons from anthropologic and cross-cultural research. Ann Intern Med. 1978; 88:(2)251-258

Kocak I, Okyay P, Dundar M, Erol H, Beser E. Female urinary incontinence in the west of Turkey: prevalence, risk factors and impact on quality of life. Eur Urol. 2005; 48:(4)634-641

Lennox N, Van Driel ML, van Dooren K. Supporting primary healthcare professionals to care for people with intellectual disability: a research agenda. J Appl Res Intellect Disabil. 2015; 28:(1)33-42

Lindsay S, Tetrault S, Desmaris C, King G, Pierart G. Social workers as ‘cultural brokers’ in providing culturally sensitive care to immigrant families raising a child with a physical disability. Health Soc Work. 2014; 39:(2)e10-e20

Lucas MG, Bosch RJL, Burkhard FC EAU guidelines on assessment and nonsurgical management of urinary incontinence. Eur Urol. 2012; 62:(6)1130-1142

Marquis B, Huston C. Leadership roles and management functions in nursing: theory and application, 10th edn. Philadelphia: Lippincott, Williams and Wilkins; 2020

McCarron M, McCausland D, Keenan P, Griffiths C, Hynes G, McCallion P. Collaborative initiatives to implement person centred practice (Report).Dublin: Trinity College Dublin; 2013

McGinnity F, Russell H, Watson D, Kington G, Kelly E. Winners and Losers? The equality impact of the great recession in Ireland.Dublin: The Equality Authority/Economic and Social Research Institute; 2014

McGurk H, MacDonald J. Hearing lips and seeing voices. Nature. 1976; 264:(5588)746-748

Minassian VA, Drutz HP, Al-Badr A. Urinary incontinence as a worldwide problem. Int J Gynaecol Obstet. 2003; 82:(3)327-338

Mladovsky P, Rechel B, Ingleby D, McKee M. Responding to diversity: An exploratory study of migrant health policies in Europe. Health Policy. 2012; 105:(1)1-9

National Disability Authority. Guidelines on person centred planning in the provision of services for people with disabilities in Ireland. 2005. (accessed 21 September 2021)

Niemczyk J, von Gontard A, Equit M, Medoff D, Wagner C, Curfs L. Incontinence in persons with Down syndrome. Neurourol Urodyn. 2017; 36:(6)1550-1556

Nursing and Midwifery Board of Ireland. Code of professional conduct and ethics for registered nurses and registered midwives. 2021. (accessed 30 September 2021)

O'Donnell CA, Burns N, Mair F Reducing the health care burden for marginalised migrants: the potential role for primary care in Europe. Health Policy. 2016; 120:(5)495-508

Oladapo Adedokun A, Wilson MMG. Urinary incontinence: historical, global, and epidemiologic perspectives. Clin Geriatr Med. 2004; 20:(3)399-407

Ostaszkiewicz J, Tomlinson E, Hunter K. the effects of education about urinary incontinence on nurses' and nursing assistants' knowledge, attitudes, continence care practices, and patient outcomes: a systematic review. J Wound Ostomy Continence Nurs. 2020; 47:(4)365-380

Perry S, Shaw P, Assassa H An epidemiological study to establish the prevalence of urinary symptoms and felt need in the community: the Leicestershire MRC Incontinence Study. J Public Health Med. 2000; 22:(3)427-434

Petry K, Maes B, Vlaskamp C. Measuring the quality of life of people with profound multiple disabilities using the QOL-PMD; first results. Res Dev Disabil. 2009; 30:(6)1394-405

Rantell A, Dolan L, Bonner L, Knight S, Ramage C, Toozs-Hobson P. Minimum standards for continence care in the UK. Neurourol Urodyn. 2016; 35:(3)400-406

Rechel B, Mladovsky P, Ingleby D, Mackenback J, McKee M. Migration and health in an increasingly diverse Europe. Lancet. 2013; 381:(9873)1235-1245

Addressing continence in children with disabilities. 2014. (accessed 21 September 2021)

Saga S, GuttormsenVinsnes A, Mørkved S, Norton C, Seim A. Prevalence and correlates of fecal incontinence among nursing home residents: a population-based cross-sectional study. BMC Geriatr. 2013; 13:(1)

Salavati D, Lindolm F, Drevenhorn E. Interpreters in healthcare: nursing perspectives. Nursing. 2019; 49:(12)60-63

Sinclair AJ, Ramsay IN. The psychosocial impact of urinary incontinence in women. The Obstetrician and Gynecologist. 2011; 13:143-148

Spradley J. Foundations of cultural knowledge. In: Spradley J (ed). San Francisco: Chandler; 1972

Stewart E. Assessment and management of urinary incontinence in women. Nurs Standard. 2018; 33:(2)75-81

Terzoni S, Montanari E, Mora C, Destrebecq A. Urinary incontinence in adults: nurses' beliefs, education and role in continence promotion. A narrative review. Arch Ital Urol Androl. 2011; 83:(4)213-216

Thakar R, Stanton S. Regular review: Management of urinary incontinence in women. BMJ. 2000; 321:(7272)1326-1331

Tunc TE. Female urinary incontinence and the construction of nineteenth-century stigmatized womanhood. Urology. 2008; 71:(5)767-770

United Nations. Universal declaration of human rights. 1948. (accessed 21 September 2021)

Van Liemt G. Human trafficking in Europe: an economic perspective.Geneva: International Labour Organization; 2004

Van Loenen T, Van Den Muijenbergh M, Hofmeester M Primary care for refugees and newly arrived migrants in Europe: a qualitative study on health needs, barriers and wishes. Eur J Public Health. 2018; 28:(1)82-87

Van Nunen K, Kaerts N, Wyndaele JJ, Vermandel A, Van Hal G. Parents' views on toilet training: a quantitative study to identify the beliefs and attitudes of parents concerning toileting training. J Child Health Care. 2015; 19:(2)265-274

Visser E, de Bock G, Berger M, Dekker J. Impact of urinary incontinence on sexual functioning in community-dwelling older women. J Sex Med. 2014; 11:(7)1757-1765

Von Gontard A. Urinary incontinence in children with special needs. Nat Rev Urol. 2013; 10:(11)667-674

Van Timmeren EA, Van der Putten AA, Van Schrojenstein Lantman-de Valk HM, Van der Schans CP, Waninge A. Prevalence of reported physical health problems in people with severe or profound intellectual and motor disabilities: a cross-sectional study of medical records and care plans. J Intellect Disabil Res. 2016; 60:(11)1109-1118

Improving continence care around the world. 2015. (accessed 21 September 2021)

National audit of continence care: combined organisational and clinical report. 2015. (accessed 21 September 2021)

Wilkinson JE, Cerreto MC. Primary care for women with intellectual disabilities. J Am Board Fam Med. 2008; 21:(3)215-222

World Health Organization Regional Office for Europe. How health systems can address health inequities linked to migration and ethnicity. 2010. (accessed 21 September 2021)

World Health Organization Regional Office for Europe. Strategy and action plan for refugee and migrant health in the WHO European Region (Report EUR/RC66/8). 2016. (accessed 30 September 2021)

Yoo GJ, Kim BW. Korean immigrants and health care access: implications for the uninsured and underinsured. In: Kronenfeld J (ed). Bingley: Emerald Group Publishing; 2007

Yoo R, Spencer M. Continence promotion and successful aging: the role of the multidisciplinary continence clinic. Geriatrics (Basel). 2018; 3:(4)

Urinary incontinence and the impact on migrant individuals with intellectual disability

14 October 2021
Volume 30 · Issue 18


Enhancing and enriching the health and wellbeing of migrant individuals with intellectual disability is essential in our diverse society. The needs of this population can be substantial, but unfortunately migrant individuals with intellectual disability face many challenges, from accessing health services, cultural complexities, financial difficulties, and language barriers, to lack of knowledge on the availability of particular services. Although a common condition, urinary incontinence remains a taboo subject and many individuals do not seek intervention even though it impacts on all aspects of their life. The migrant individual who has an intellectual disability may be unable to understand information that is provided, unable to gain knowledge, access educational material to promote continence and manage incontinence. This article considers what is known on the subject of urinary incontinence for an individual with intellectual disability from the migrant community in Ireland.

In Ireland the entire population profile is continuously changing, from paradigms of gender, ethnic groups, abilities, race, to specific scenarios and religious creed. A substantial percentage of the population today living in Ireland are non-national in origin, with the Irish Census for 2016 confirming that 17.2% of the population were foreign born (Central Statistics Office (CSO), 2017). The term ‘migrant’ is defined by the International Organization for Migration (IOM) as

‘Any person who is moving or has moved across an international border or within a state away from his or her habitual place of residence, regardless of the person's legal status, whether the movement is voluntary or involuntary, whatever the cause for the movement is or what the length of the stay is.’

IOM, 2010

This term covers a broad range of people: asylum seekers and refugees, travellers, Roma, documented and undocumented migrants; from individuals who have recently settled in Ireland to people who are resident in a country for years (Health Service Executive (HSE), 2018). Historically, when minority ethnic individuals arrived in a new country, the main focus of concern was on personal protection, shelter and safeguarding (HSE, 2018). Consideration is now given to a balance between addressing individuals' healthcare needs and supporting their social needs (HSE, 2018). Migrant communities who come to reside in another country can consist of dramatically diverse groups of individuals; however, it is commonly found that many are young in age profile and vulnerable in nature (Van Liemt, 2004). Healthcare organisations worldwide must implement strategic, operational change management plans and policies so that quality health outcomes are achievable for all individuals (Marquis and Huston, 2020).

Nationally and even internationally the precise proportion of individuals with intellectual disability is unknown, this is due to the under-representation of people with mild intellectual disabilities in official reports (Keenan and Doody, 2007). In 2016, the Irish Census recorded that 66 611 people had an intellectual disability, representing 1.4% of the population in Ireland, whereas the international prevalence rate for people with intellectual disability has been estimated to be 2% of the population (Department of Health (UK), 2001). Individuals with an intellectual disability are at higher risk of developing health problems and comorbidities such as bladder dysfunction compared with their peers in the general population (Petry et al, 2009; Doyle et al, 2016; Van Timmeren et al, 2016). Although urinary incontinence affects a large proportion of people with an intellectual disability, awareness and actions to address their incontinence needs are minimal (Lucas et al 2012; McCarron et al, 2013).

Article 1 of the United Nations (UN) Universal Declaration of Human Rights states:

‘All human beings are born free and equal in dignity and rights. They are endowed with reason and conscience and should act towards one another in a spirit of brotherhood.’

UN, 1948

In addition to respecting this, health professionals must also adhere to their own professional code of conduct, which advocates that they adopt a non-judgemental approach, with equal respect for all individuals they engage with (Nursing and Midwifery Board of Ireland (NMBI), 2021). Within their role health professionals must not discriminate against individuals due to age, sex, race, religion, civil and family status, disability or being a member of the traveller community (NMBI, 2021). It is crucial that migrant individuals engage with health services to ensure their specific health needs are addressed and to make sure that a quality service is delivered to them, where attainable positive health outcomes are achieved (HSE, 2018) Strategic health planning in Ireland is based on the principles of accessibility, equality and social inclusion, thus promoting health care for all individuals in the population (HSE, 2015).

The aim of this article is to appraise the available evidence-based literature in relation to what is known about migrant individuals with an intellectual disability who experience a specific health problem: urinary incontinence.

Urinary incontinence

Urinary incontinence is a significant health problem in contemporary society, with 50 million people worldwide estimated to be affected (Kocak et al, 2005). Abrams et al (2017) argued that, globally, urinary incontinence is underreported, undiagnosed and overlooked by individuals, families, professionals, communities, policy makers, and global governments. Urinary incontinence is described as involuntary leakage of urine in an inappropriate place (Abrams et al, 2010). It can have psychological, social, sexual and emotional consequences such as anxiety, depression and social isolation, in addition to physical consequences such as incontinence-associated dermatitis, increased risk of falls and premature admission to residential care (Elstad et al, 2010; Visser et al, 2014; Wagg et al, 2015).

In general, the prevalence rates of urinary incontinence can range from 9% to 34% of the population (Perry et al, 2000; Thakar and Stanton, 2000). Prevalence rates vary depending on the definition used to describe incontinence and also vary by gender, with women reporting prevalence rates ranging from 8% to as high as 58% (Huang et al, 2006), while for men the prevalence rates are approximately half that of women (Buckley and Lapitan, 2010). Incontinence knows no age limits; this is evident with 10% of children aged 7 years experiencing nocturnal enuresis (Buckley and Lapitan, 2010). In a cross-sectional study in Turkey of 2353 primary school children, 8% displayed daytime wetting symptoms (Bolat et al, 2014).

Urinary incontinence is a common condition but many individuals do not seek help (Harris et al, 2007; Terzoni et al, 2011). In some cultures, seeking help for urinary incontinence may be seen as causing shame and embarrassment for their community (Isaksen, 2002; Tunc, 2008). Many individuals from minority ethnic groups do not report, or seek help for, urinary incontinence due to feelings of humiliation and the view that nothing can be done to promote, treat or even manage bladder dysfunction (Doshani et al, 2007). In some cultures, urination is theoretically a strictly secretive act and having an incontinence episode in public would be an outrageous occurrence (Isaksen, 2002). Marginalised minority women are extremely reluctant to request medical intervention for incontinence (Kinchen et al, 2003; Minassian et al, 2003; Horrocks et al, 2004; Elstad et al, 2010).

There are many reasons why migrants do not seek help for health conditions in general—not only cultural challenges but also the inability to speak the language of their new country of residence, financial difficulties, lack of health insurance and unawareness of availability of healthcare services or problems accessing these (Yoo and Kim, 2007; World Health Organization (WHO) Regional Office for Europe, 2010). Citizens of the European Union have advanced healthcare mechanisms and yet migrants face countless complexities in and challenges to accessing care (Doyle et al, 2009).

Positive interventions

Urinary incontinence can impact on an individual's quality of life at any age and indeed across all ethnic groups, thus continence promotion initiatives should be developed and delivered from potty training to pelvic floor exercise programmes (Australian Institute of Health and Welfare, 2013; Harris-Kojetin et al, 2013; Saga et al, 2013; Gorina et al, 2014; Higami et al, 2019). Positive, progressive innovative interventions are available to treat urinary incontinence, which can transform the lives of individuals experiencing bladder and bowel dysfunction. That said, health professionals must be cognisant of a person's cultural views, beliefs, attitudes and their distinctive demands and desires (Oladapo Adedokun and Wilson, 2004). The principles of compassion, care, privacy, partnership approach, respect and sensitivity should be applied to all continence care interventions from toileting, to changing disposable continence wear, to skin care (Health Information and Quality Authority, 2014). Knowledgeable health professionals can promote positive continence promotion interventions, rather than just passively prescribing continence wear products (Ostaszkiewicz, et al, 2020).

Albers-Heitner et al (2008) found 50% of individuals with urinary incontinence were passively prescribed disposable incontinence wear products, rather than proactively receiving assessment and positive continence promotion interventions. Individuals who experience urinary incontinence can introduce lifestyle interventions such as decreasing caffeine intake, consuming a diet high in fibre to prevent constipation as it can exacerbate urinary symptoms, introducing pelvic floor exercises, and bladder-retraining programmes (Du Moulin et al, 2005).

Urinary incontinence and intellectual disabilities

Urinary incontinence can affect all sections of the population; with symptoms having a devastating impact on health for the individual (Terzoni et al, 2011; Keenan et al, 2018). Equality of access and availability of continence promotion service is required regardless of the individual's ability or disability (Rogers and Patricolo, 2014; Keenan et al, 2018). Living with a disability is challenging and complicated, especially if the individual has a chronic medical condition as well, which may have negative impacts on both physical and psychological wellbeing (McGinnity et al, 2014). Urinary incontinence symptoms are multidimensional and can critically impact on an individual's holistic wellbeing, having physical, psychological, and social health consequences (Sinclair and Ramsay, 2011).

For example, for individuals with Down's syndrome, achieving continence control can be complicated, complex and challenging with incontinence episodes occurring regularly (Niemczyk et al, 2017). Urinary incontinence incidence for individuals with Down's syndrome are as high as 64%, in children aged 4-12 years (Niemczyk et al, 2017). Continence promotion interventions and toileting are essential to ensure individuals achieve dryness and cleanliness (Van Nunen et al, 2015)

Unfortunately individuals with intellectual disability are at higher risk of developing urinary incontinence, yet only minimal reference is made in the literature to this section of the population with bladder and bowel dysfunction (Lucas et al, 2012; Keenan et al, 2018). Wilkinson and Cerreto (2008) identified that women with intellectual disability receive inadequate care in relation to specific health issues such as menstruation, cervical and breast cancer screening, contraception and osteoporosis. However, there is a lack of research on urinary incontinence in women with intellectual disability.

Von Gontard (2013) identified that many children with special needs do not receive adequate continence promotion interventions and it is advocated in the literature that a multi-factorial treatment approach is developed, which would begin with a holistic continence assessment. In Ireland, the Code of Professional Conduct and Ethics for Registered Nurses and Registered Midwives (NMBI, 2021) outlines that nurses and midwives should respect all individuals irrespective of the person's age, gender, race, religion, family status or disability—this would include delivering quality continence care to migrants with an intellectual disability. More research is needed on the subject of urinary incontinence for all individuals with intellectual disability, so that health professionals can provide proactive incontinence care and achieve improved quality continence promotion outcomes.


In Europe there are many inequalities affecting individuals and the health of migrants can be threatened by poor living conditions, inability to access health care, or scant communication and language skills (Rechel et al, 2013; Van Loenen et al, 2018) Rightfully it is acknowledged that all individuals residing in European states have the right to health care; however, this can be challenging for many migrants (WHO Regional Office for Europe, 2016). Recently, there has been an increased interest in the health of migrants worldwide (O'Donnell et al, 2016). This may be due to the rise in the need for migrant workers owing to labour shortages and the decrease in birth rates in some nations (O'Donnell et al, 2016).

All individuals have their own specific cultural uniqueness. Culture can be defined as the:

‘Learned and shared knowledge, beliefs and rules that people use to interpret experience and to generate social behaviour, it can permeate multiple domains across society.’

Spradley, 1972

Kleinman et al (1978) outlined that illness can be influenced by the person's cultural circumstances, which echoes a previous definition of illness, which claimed that:

‘Illness represents personal interpersonal and cultural reactions to disease or discomfort.’

Fabrega, 1972

Health care should be delivered in a culturally sensitive style that combines compassion, consideration and empathy for the individual's values, aspirations and ambitions (Lindsay et al, 2014). Fortunately some migrants settle and integrate into Irish life effectively; this is enhanced if individuals have equality of access to health services (HSE, 2018). Access to health care for all individuals is enshrined within international legislation, rights and rules such as the European Charter of Fundamental Rights (Rechel et al, 2013). However, although such rights may be set down legally in government documents, practically the picture maybe very different, for culturally vulnerable migrants (Mladovsky et al, 2012).

A family tool such as a culturagram is a mechanism for child health professionals to build up a picture of migrant parents' experiences and understanding of lived experiences, accomplishments, challenges and complexities (Congress, 2008). The culturagram assists in providing individuality and independence concepts for families who have distinctive cultural needs (Congress and Kung, 2020). Health professionals should have enhanced engagement with migrant parents who have a child with additional needs, thus increasing parents' knowledge and understanding about healthcare requirements, to aid in achieving parents' and children's hopes, aspirations and expectations (Calder, 2017). Health professionals need to have cultural competences to increase connection, inclusion and teamwork with families who have a member with a disability (Calder, 2017). Another framework such as Kleinman's Explanatory Model (Kleinman, 1980) gives health professionals structure on parents' beliefs, views and thoughts about their child who has a disability.

It is indisputable that people with intellectual disability experience health inequities (Lennox et al, 2015). Person-centeredness care principles should be established, and embraced to enhance a partnership process between health professionals and the individuals with intellectual disability to provide effective inclusive objectivity to their health (National Disability Authority, 2005; McCarron et al, 2013).

On the wider scale, governments should develop policies, procedures and protocols to ensure equal opportunities are provided to all individuals no matter what their diversities are and regardless of their country of origin (Hegarty, 2017). Policy makers need to cease cutting financial funding to health services and offer financial assistance and support to deliver quality care to the most vulnerable in society, promoting good health outcomes (O'Donnell et al, 2016).


The health of migrants is a critical concern for each and every citizen within society. However, intersectional, multidisciplinary collaboration is essential with all stakeholders to ensure the evolution of quality health and wellbeing services, thus reducing inequalities for the migrant population (Faculty of Public Health Medicine (FPHM), 2016). Disparities for migrants' health and wellbeing cannot be dealt with in isolation, as inequalities significantly impact on social fairness and cross-sectional factors such as education, housing, employment and childhood development (FPHM, 2016). The Irish Census for 2016 (CSO, 2017) identified that 612 012 residents in Ireland spoke a foreign language at home; not being proficient in the English language deepens difficulties in accessing health services, optimum verbal dialogue is the most instinctive means of communication for all people (McGurk and MacDonald, 1976).

Central to delivering and receiving quality health care is the concept of effective and efficient communication (FPHM, 2016). It is essential that health professionals have the ability to communicate effectively to ensure quality health outcomes for service users (Donnelly and Neville, 2008). Unfortunately, the availability of translation/interpreter services is inconsistent across health services; subsequently this lack of interpretation provision creates communication obstacles, which builds barriers between providers and service users (FPHM, 2016). Communication is a central component of healthcare interactions with migrant parents of children with disability (Calder, 2017). Knowledgeable, accessible translation services are essential and these facilities should be offered and obtainable for all families who need this service (Calder, 2017).

Primary care health services should not only be clinically focused, services must also encapsulate cultural and linguistical competences to facilitate migrants integrating into their new community (FPHM, 2016). Communication between health professionals and users of healthcare services needs to develop into a therapeutic interactive relationship to reduce helplessness and vulnerability for individuals, and facilitate an environment where joint decisions about personal care and proactive treatment occur (Donnelly and Neville, 2008). The use of an interpreter is an essential method for communication for nurses when engaging with migrants who require services; however, it is reported that robust education is necessary for nurses to effectively and efficiently use interpretation services (Salavati et al, 2019). In addition to migrants' needs, health professionals require support and assistance to enhance communication links, to ensure quality health outcomes for individuals, their families and the collective communities (HSE, 2018).

Incontinence symptoms for individuals may cause dejection and depression so it is imperative that all health professionals are aware of the need to communicate compassionately and caringly, to assess, promote and manage incontinence symptoms (Yoo and Spencer, 2018). Effective communication is essential, with the use of user–friendly words and the avoidance of technical terminology (Rantell et al, 2016). For many individuals, urinary incontinence is a discomforting and distressing condition to discuss with health professionals (Wagg, 2015). Clear, concise and confidential communication, collaboration and consultation between health professionals and individuals are required for proactive intervention strategies, rather than passive incontinence management interventions (Stewart, 2018).

Writing this article prompted the development of an ‘easy read’ leaflet, ‘Going To The Toilet’, which will assist individuals with an intellectual disability, and their families, from migrant communities. Irrespective of race, religion, culture, nationality, or ability, all individuals who experience urinary incontinence should have clear, easy-to-understand information to overcome the distressing symptoms of urinary incontinence.


Urinary incontinence can dramatically impact on an individual's physical, psychosocial and emotional wellbeing; resulting in decreased quality of life. However, in addition to the personal cost of incontinence, the financial impact for society is also detrimental. For individuals who migrate to a foreign country there can be a negative impact on their health and wellbeing due to the disparities in health services. Realistic, valid reasons have been reported for why migrants face difficulties accessing healthcare services, from language barriers and lack of knowledge on service availability to cultural challenges. For migrant individuals who have an intellectual disability, the capability to engage with health services can be even more challenging and complex. Nationally and internationally robust evidence-based healthcare interventions should be delivered to all individuals no matter their ability, race, creed or religion, to ensure integration of entire populations into society.

There is a long history of migrants residing in Ireland, however it is important to be aware of their health needs in the area of continence promotion and management of incontinence. Health professionals must openly acknowledge deficiencies and discrepancies in their knowledge of evidence-based continence care to the migrant individual with intellectual disability. Unfortunately promotion of continence and management of incontinence education programmes is scant, sparse and poorly resourced. Further research and educational information is required for health professionals, carers, families and individuals on the subject of urinary incontinence.


  • Urinary incontinence is a common condition that can impact on individuals' health and wellbeing
  • Migrant individuals may not even openly report, discuss or seek help to treat and manage leakage of urine. This is further exacerbated if the individual has an intellectual disability
  • Health professionals must have the clinical knowledge, ability, skillfulness and competence to promote and manage urinary incontinence for the migrant population with an intellectual disability to ensure quality health outcomes

CPD reflective questions

  • What challenges may individual migrants face when trying to access health care once they arrive in a new country?
  • How can nurses acknowledge the cultural needs of individuals with intellectual disability who experience incontinence?
  • Drawing on your clinical experience and education, what implications does urinary incontinence have for an individual's health and wellbeing?
  • How can communication be enhanced between health professionals and individuals with intellectual disability who experience incontinence?